24004 76TH AVE W.PDFlill 11111111
6452
24004 76TH AVE W
ADDRESS:
TAX ACCOUNTMARCEL NUMBER:
BUILDING PERMIT (NEW STRUCTURE):
COVENANTS (RECORDED) FOR:
CRITICAL AREAS: ;W& — DETERMINATION: 0 Cond . itional Waiver 0 Study Required 9�aiver
DISCRETIONARY PERMIT #'S:
DRAINAGE PLAN DAT
PARKING AGREEMENTS DA'
EASEMENT(S) RECORDED FOR:
PERMITS (
PLANNING DATA CHECKLIST DATED:
SCALED PLOT PLAN DATED:_1 11 ZJ o U
SEWER LID FEE $:
SHORT PLAT FI
SIDE SEWER AS BUILT DA
SIDE SEWER PERMIT(S)
GEOTECH REPORT DATED:
STREET USE I ENCROACHMENT PERMIT
WATER METER TAP CARD DATED:
LID #:
LOT- BLOCK:
OTHER:. ?oov-a�, f?09)
LATEMP\DSrs\Fomis\Street File Checklist-doc
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APPLICATION
for
The City of Edmo SIDDE SEWER PERMW
OUTSIDE 0 INSIDE 0 REPAIRS 11
OWNER .......... 6; ij ........
HOUSENo. .... ......... ............ I .....................
w
CARD No . ......................
EASEMENT No. .— ............ ..... ......
........ ............................. CONTRACTOR ....... .. .... PERMIT
.............
STREET
......... ......................... — AVENUE LOT No . . .. ...... ............ . .. ... ................. .. BLOCK No. .....................................
NAME ADD ........
............... ................. .
X
lz�ll
S
Date
BACKFILL WORK ORDER ISSUED ............................................ DEPOSIT, ..........
SEWER WORK ORDER ISSUED ............................... - ...............
Approved:
DATE.�.�._ BY .......
NOTICE:
No warranty of accuracy.
The information shown on the attached
map(s) was compiled for use by the City of
Edmonds, its Employees and Consultants.
The City of Edmonds does not warrant the
accuracy of anything set forth on these
map(s). Any person or entity requesting a
copy should conduct an independent
inquiry regarding the information shown on
the map(s), including, but not limited to,
the location of any sewer stub shown. Such
sewer stubs may or may not exist and may
or may not exist at the location shown.
Neither the City of Edmonds nor its
employees or officers shall be liable for the
information given on this map(s), nor for
any one representation provided based
upon said map(s).
0 10
PLANNING DATA (n,)
11 STREETfLLEJ
Name: WaNa.,v, N -c-,
Date: 0S.01.?,,()0(
p
SiteAddress: iLFDO+ TUTH Arvtl W
Plan Check #: BLD-2006- 0 8
Project Description: N4eW l5j5 + aV-4 If
Reduced Site Plan Provided: (0) NO)
Zoning:
MapPage: ()()(p --Tcorner
Lot: (YES /(9
Flag Lot: NO)
Critical Areas Determination #: Ce P-A - I-0 04P - 0 0 [5 9
El Study Required
H Waiver
SEPA Determination:
Exempt 6 /4j�VC) C--Yclev w-acting
El Needed (for sites with 500 cubic yards of grading or within 200 feet of Puget Sound or Lake
Ballinger. Requires: (1) Fee, (2) Environmental Checklist, and (3) APO List with notarized form).
Req Setbacks
Sti-e:
4- 5
Side:
Side:
Rear.
W 4-57
ActualSetbacks
-6�ee
Side:
!��
C
Side:
I C—
lio Detached Structures: e,*4- 62.8 V%t.W
El Rockeries: 1--> yyt e"-r-* vrw 4 uc-�
El Fences/Trellises:
El Bay Windows/ Project! ng Modulation. 'rivilmA01
Stairs(�� "7, 0 e,%.
Parking Required:
Parking Provided:
LotArea: J'2,)9':J-J Ep 31V-P.-Vi UM
.4 (�,
LotCoverage:
Lot Coverage Calculations: ""' GHL -t- Z-02, CleAoy— 4- 56,t V1.tW OAV-43C
+ 56LV-A je� = &OVC*-4
Building Height
Datum Point: 4�p H
Datum Elevation:
MaximumHeight:
Actual Height: 1 0 6
ADU Created: (YES 0-f OL A A-P 6too,
Subdivision:
Legal Nonconforming Land Use Determination Issued: (YES /(9
Other
A? 1,58, (0
+ -r VF:� - 5
2-57+ - 71 max Vu4tetq
1, q::� � D
PlanReviewBy: gf;W ae�
P V
0
E
Water Service Drawing
The City of Edmonds EASEMENT NO . ............................................
NEW CONSTRUCTION El REPAIRS C4, LID NO . .................. . ASMT. NO . ........
OWNER....................................... ... CONTRACTOR ......... .................... ................................................... - PERMIT P40 . ....................
LEGAL DESCRIPTION: LOT,.NO . ...................................... BLOCK NO . ..................................
JOB ADDRESS lq0-CA ...... :7YP-N\ ............... .......... ....................
NAMEOF ADDITION .............. .................................... ......... ........................................... ...
, to
I �
3/� +0 1
) co i
Approved:
MMOOW-1 1175 (REV.1, 1178) DATE .................. By ... W6 ................................................
#P20
City. OPEdmonds
Development Services Department
Planning Division,
Phone: 425.771.0220
Fax: 425.771.0221
— L;. I a 7
Date Received: V'RK
City Receipt #:_ 2NZ'6AG
Critical Areas File #: Q&�-05_5
Crit I ical Areas Checklist Fee: $135.00
Date Mailed to Applicant:
The Critical Areas Checklist contained on this form is to A property owner, or. his/her authorized representative,
be filled out by any person. preparing a Development must fill out the checklist, sign and date it, and submit it
Permit. Application for the City of Edmonds prior to to the City. The City'will review the checklist, -make a
-his/her submittal'of the application to the City. -precursory site visit, and, make a determination of the
subsequent steps necessary to complete a development
The purpose of the Checklist is to enable City staff to 'drnit ication.
. ,, 0 appl
determine whether any potential Critical Areas are, or
may be, present on. the subject property. The infbrmation�k- Please submit a vicinity �map, �albng with the signed copy
needed to complete . the Checklist should be easily of this form to assist City staff in finding and locating the
--fr - 'b of I pf op &ty -, described'on this form.. In,
aviailible, oni o 'servitions of the site'or dati a �Ailable at' speci c piece
City Hall (Critical areas inventories, -maps, or soil addition, the 'applicak. shi'li include other pertinent,
Su I rvey§). A, information (e.g. site �.plani. Aopography I- map, ptc.) or
studies in conjunction with -this Checklist to assistant staff
RISC in completing their preliminary assessment of the, site.
AP 2
R
ffifi§� and assigns,:in consideration on the processing of the, application agrees
The undersigned applicant, an
ity of Edmonds harmless from an y and � all damages, . reason
to release, indemnify, defen91:UWoM!the-C �luding able
�attorney's f�es, arising from.any action- or- ififtaction.- based in whole or, part upon false, misleading, inaccurate or
incomplete information ftimished-by the applicant, histher/its agents,or employees-*:.
By, my signature, I certify that the, information and exhibits herewith submitted*relrue, and, correct, to-Ahe best of my
knowledge and that I am authorized to fi the behalf of the owner as Jisted
DATE
GATuRE oF APPLicANT/AGENT sut 10;
SI 0
Propiwty Owner's Authorizatiom. .
'60ny siiiiature, I cer* that I have.authorize' the _ply. for the subject land use application,
d. aboC)pplicant/Agent to ap
and granti'my perniiiission fouthe public officials and t . lie staff of f Edm�',nds "to "enter the subject pro p-erty'' for the
_e i ?
on and postin attendant tolhisaDnlication.
purposes of inspecti
CAM J 11A -A DATE
e _51
SIGNATURE O.F OWNER 7a7L'
J
A-pp&ant-
� t-& - ��Ve)
_:N, ame.'
Strpet-Address
6�
city State zip
te-lephpne:
Email address (optional):
OT
Appliaantl�epres ntati ,
Nvv u
Name
Z
'b k
:/7
Street Address
f/, & b
City tAte r
Telephone(e�_
Email Address (optional):
#P20
CA File No:
Critical Areas Checklist
.Site Information (goils/topography/hydrology/veg'etation)
l. Site Address/ Ipcation: Moo
2. Property TaxAccount Number: 9 1 0 00 0 q 15,
3. Approxuinate Site Size (acres or squ feet)
4. Is this site currently develo ed? 7rpes;=
p no.
7
If yes; how is site developed?
5. the general site topography. Check allthata' I
Tp y
Flat less than 5-feet elevati
on changelover entire site..
'Ro g- s.9pes it ally less' than . Ve
on sie gener 15-1.1 rtical.rised 10-feet over a oriiontal
di.9tance of 66-feet)..
Hilly: slopes present on site.of more than 15% and. less than 36% (a vertical rise. of 104eet
over a horizontal distance of 33 to 66-feet).
�teep: grades of greater than 30% present on site (a�Vertical rise of 10-feet over a horizontal
distance of less than 33-feet).
Other (Olease describe):'
6. Site contains areas of year-round standing water:-- Approx. Depth:
7. Site contains areas of seasonal standing water: Approx�/Depth:
What season(s) of the year?
8. Site is4n the floodway floodplain
Of a watercourse.
9. Site conWjq(s a creek or farea where water flows across the grounds surface? Flows- are year-round?
ows
ows are seasonal? (What time of year?
10.
forested meadow shrubs mixed
urban larifdscaped (lawn', shrubs etc)
06% d is present on, site
ous Wetlan
For City Staff Use Only (00(a)
1. 1��Aeck, Number, if applicable? W Dyle, QI V-evl-
2. Site is Zoned? . P_ 5 — 49'.
3. SCS mapped soil type(s)?. 6- A- I C1 "W D b ot - LA v 0 cA yj I vi ct'(,o Me J e)�
X6 elo
4. Critical Areas inventory or map indicates Critical Area. on site? Q Vle,,' �2 �j o \bVl.
5. Site within designated earth subsidence landslide hazard area?, - M 0
DETERMINATION
Reviewed by -
STUDY REQUIRED
W
Date: 051111 1,00(0
WAINER
PE�.,,;JT SUBMITTED BY
GTE
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LA
LEGM-ID
P:- r%
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OVERHEAD UNES—
I.D. UTJLITY POTHOLE C=
UC TRENCkINC ----,JCT—
R. 0. W.
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NO. 7. 57
rLAS-41tz—AL—mirsHALL BE INSTALLED AT
EACH 5 1 GN F GHT—TIME USE.
2. OI�TANCES UAY VARY AS APPROVEO By THE
IENG I MEER
3. FLAGCERS REOVIRED TO CONTROL TRAFFIC
"4ENEVER THE CONTRACTOR WJST INTERRUPT
TRAFFIC FLOW TO ACCESS THE wORN Sire
WITH WATERIALS OR EOUIPWENT.
El CONE OR CHANNELIZING DEVICE
(SEE STO 702)
YMK AREA
TRUCK WiTH
rLASHING OR
BEACON t
so, UIN
vaum
zoo*
SHOOLD
W011K
TRAFFIC CONTROL PLAN
SHOULDai WOW
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1?03
Cityl6f Edmonds 1� 6 *� Permit No:
RIGHT-OF-WAY CONSTRUCTION PERMIT Issue Date: 011411qrl
Ty
Ae of Work (be specific
, I r*% - I _L
C. Contractor: 6TF- IV09 6) Contact: eT,_CAJfC_ eAZ1n18kC_2A 4�2�-7714W
5A�,ePJZ01V65,P9rA1,r COOR1011V141roR
-7/0- 133
Mailing Address:131,1-C 6).. 0_A,,�1AJ0`k8 F-0EAdt Phone 5
State License #: AA Ir-1 . 0 It(u)
Liability Insurance:- BorQ:-$') q
e .4
4.
D. Building Permit # (if applicable): Side Sewer Permit # (if applicable)-,
E. Commercial
Subdivision
CityProjec� EUC(PUD 1UT PSE, CHAMBERS, OVWD)
Multi -Family
Single Family
Other
TE 100 0/?/o0.- 000/ 08 .203-_)b
INSPECTOR-
92-4
Ig
a C CAT5. r.Acti
F. PAVEMENT:
YES
F� NO
G. SIZE OF CUT x H. Charge:
CONCRETE CUT:
E] YES
F� NO
APPLICANT TO READ AND SIGN
IDEMNITY.- Applicant understands by hislher signature to this application helshe.holds the City of Edmonds harmlessfrom injuries,
damages or claims of any kind or description whatsoever, foreseen or unforeseen, that may. be made against the City -df Edmonds or
any of its departments or employees, including but not limited to the defense of any legal proceedings including defense costs and
attorneyfe& by reason ofgranting this permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL
INSPECTION AND ACCEPTANCE OF THE WORK ESTIMATED RESTORATION FEES WILL BE HELD UNTIL THE FINAL STREET PATCH IS
C4MPLETED BY CITY FORCES, AT WHICH TIME A DEBIT OR CREDIT WILL BE PROCESSED FOR ISSUANCE TO THE APPLICANT.
* Traffic control and public safety shall be in accordance with City regulations as required by the City Engineer. Every
fl kgger must be trained as required by (WAC) 296-155-305 and must have certification verifying completion of the
re4u'ired training in their possession.
* Resioration is to be in accordance with City codes. All street -cut trench work shall be patched with asphalt or City -
approved material prior to the end, of the workday - NO EXCEPTIONS.
* Thre6.sets of construction drawings of proposed work are required with the permit application.
IHAVEREAD THE ABOVE STATEMENTS AND UNDERSTAND THE PERMIT REQUIREMENTS AND ACKNOWLEDGE
THA T I MUST MAKE THE PINK COPY OF THE PERMIT A VAILABLE ON SITE A T ALL TIMES FOR INSPECTIONS
sign
pq
Dave Hawkins, Sec(Am0rXftngeAgft*ess Design
9/01/99
CALL DIAL -A -DIG (1-800-424-5555) PRIOR TO BEGINNING WORK
FOR CITY USE ONLY
00
Apptoved Right-of-way Fee:- 1)
Time Authorized:,,, Y-61d',Nfter cA Disruption Fee/Fund'111:
Special Coqd4t1ons--..:,, A 'Restoration Fee:
Total Fee�
21 J;_
ii.ec'eipt N
Issued -by:
UPON COMPLETION OF PERMITTED WORK, AN ENGINEERING FINAL -
INSPECTION IS REQUIRED PER CHAPTER 18.00 OF THE EDMONDS
COMMUNITY DEVELOPMENT CODE.
FINAL APPROVAL OF PERMITTED WORK.
INSPECTOR'S SIGNATURE DATE:
For inspection requirements see Engineering Information Handout.
No WORK SUIALL BEGIN PRIOR TO PERM ITISSUANCE
7640
7630
Comcast of Washington, LLC
1525 75th Street SW
Suite 200
Everett, WA 98203
Contact: Kermit Benson 425-263-5362
North Drop
Node: EM35
24004 76th Ave W - City of Edmonds
shoulder of ROW for
approx 40', bore d/w
for approx 44' and
set carson
APPROVED AS NOTED
BY ENGINEE ING
Date:
239th pi SW
N
W E
S
NORTH NOT TO
SCALE
Work Details
Open trench in shoulder of ROW for approx 40 feet, bore combined driveway for approx 44 feet m/I and set carson to extend
and bury CATV service drop to 24004 76th Ave W.
Install cable at 36" depth.
All disturbed areas will be restored to existing or better conditions.
Backfill material will be mechanically compacted to 95% of maximum density as specified by the City of Edmonds. In tight
corridors hand trenching will be utilized to ensure protection of other utilities. Contractor must locate all existing utilities
impacted by this project.
Please see attached plans for restoration, erosion control and traffic control. Erosion control will consist of placing filter fabric
fence and/or sandbags along curbs and catch basins where necessary. Keep drainage system clean and functioning. Remove
all debris from the work site. Streets and roads will be cleaned both during and after installation of work.
1,7
City of, Edmonds
RIGHT-OF-WAY CONSTRYCTION PERMIT
Permit No: a
Issue Date: -0 IV
A. Address or Vicinity of Construction:
B. Type of Wor� (be specific): 43f eM '�J? 01,kJde41- al C0 (PY Ka
4(0--F+ � 6o(-Q_ h6C;;t,-1 F),_Ax�b c Q__ -6y 4 q::Et M K, 5 e-4 c a�r 3 L6i
C. �ontractor:(��Ca Z_ L c-_
Mailing Address: t7sf� S_+ 4 1; VJ
*-7,W
Stdte License #:
City Business License #:
D. Building Permit # (if applicable):
r
Contact: (FIr Yr so-yl
Phone: 2- S_ , 6-3, 5 (,-_-1
Liability Insurance: Bond:
Side Sewer Permit # (if applicable):-
E. Commercial El Subdivision Ej City Project DL EUC (PUD, VERIZON, PSE, COM GAST, 0 VWSD)
4
x
0 Multi -Family Single Family Ej Other
INSPECTOR: Adr, C-0 14 N,!5� I-L /-/A, W Ac- I
F. PAVEMENT CUT: E]YES [:1 NO G. SIZE OF CUT x
CONCRETE CUT: El YES Fj NO
XL Mail Approved Permit Call for Pickup
INDEMNITY. Applitant understands by his/her signature to this application helshe holds the City of Edmonds harmless from
injuries, damages or claims of any kind or description whatsoever, foreseen or unforeseen, that may be made against the City of
Edmonds or any of its departments or employees, including but not limited to the defense of any legal proceedings including defense
costs and attorneyfees by reason ofgranting this permit.
THE CONTRACTOR IS RESPONSIBLE FOR WORKMANSHIP AND MATERIALS FOR A PERIOD OF ONE YEAR FOLLOWING THE FINAL
INSPECTION AND ACCEPTANCE OF THE WORK ESTIMATED RESTORATION FEES WILL BE HELD UNTIL THE FINAL STREET PATCH IS
COMPLETED BY CITY FORCES, AT WHICH TIMEA DEBITOR CREDIT WILL BEPROCESSED FORISSUANCE TO THEAPPLICANT,
* Traffic control and public -safety shall be in accordance with City regulations as required by the City Engineer. Every
flagger must be trained as required by (WAC) 296-155-305 and must have certification verifying completion of the
required training in their possession.
* Restoration is to be in accordance with City Codes. All street -cut trench work shall be�,patched with asphalt or'City-
approved material prior to the end of the workday --' NO EXCEPTIONS.
* Three sets of construction drawings of profiR-s-edwork are required with the permit application.
CALL DIAL -A -DIG (1-800-424-5555) PRIOR TO BEGINNING WORK
I HA VE READ THE ABOVE STATEMENTS AND UNDERSTAND THE PERMIT REQUIREMENTS AND ACKNOWLEDGE
THA T I MUST MAKE T14E PINK COPY OF THE. PERMIT A VAILABLE ON SITE A T ALL TIMES FOR INSPECTIONS
Date:
Signature:
(Contractor or Agent)
FOR. -CITY
USE"ONLY
-b A
Approved, Rjg4�-of
Y:
A�
Kfuvtiofi.FW,Fuid 1 1
Time Authorized oid. After; '4
Special Cond'itions:.&C._ 14 7— m"A.-4 ro. &*6-Inpecti6fi�fee:-2,02
ANQZ,22 Pr-rrC-e_ r,CND t 7-/ON tS�. Totaffee'
2
A41 0. <,C- 7-47A e-,�r Fo2oA4,A"_ 7-y.t,)�c t:�CNeeceipt,No:'�.':.
117-/�_'1-77,�S 61L)4719742 (��a LA 4_/�' ls�u ed"
LQ- A TI=
F A" 1 7 7
A F 7;r- /N JZF'!ql D, t-4 A i r.
N 4, ?ja4o_R__ -7r) 7-HC_ s>77�9 g;r AN o
REQUIRED INSPECTIONS:
Call 425- 771-0220, Ext. lj26for a 24-hour voice-reco ection request line.
FINAL APPROVAL OF PERMITTED WORK: 0 DATE:
Inspector's Signature
CADocuments and SettingsTurtisNy Documents\Fomis\Engnmg\ROWpemit_.doc Revised 10/01/03
E
40
0
S7
�v' 01- �0',N S''I",
Depth, Cleaning, Containment,
Compaction, and Restoration
Depth =
*
36-inch minimum
10
-Compatible w/
other utilities
Shoring required
at 4-ft +____
Pavement Cuts
1*
T-cut 1-ft wider
than trench
Neat -line saw -cut
edge
p
C 0
• All trench backfill shall be mechanically
compacted to 95 percent of maximum density
using 1 -ft loose lifts with whacker or 2-ft loose
lift with a hoe pack.
• If proper compaction cannot be achieved with the
native material, new import material is required at
the 95 percent rate.
• As an alternative, CDF can be used in a design
mixture approved by the Engineer.
Ccomcast
t
Te
nl-ng
CLEANING: All Streets and roads are required to
be cleaned and swept both during and after the
installation work.
*—Mechanical Vacuum is preferred -method
CONTAINMENT: All un-restored. shoulders or
material storage areas are required to be contained
with reflective barricades.
'R, 5",
.1.,,',',,,'Re:st6rat10h,
All disturbed areas s hall be restored to
existing or better conditions
Trench parallel to road-.!
* Shoulder - Match existing surface conditions
* Pavement - 6 1/2 inches of crushed surfacing material
and asphalt concrete Class B at 2- inches minimum or
same thickness if greater..
Trench across road (immediate cold rnix patch):
1* Asphalt - Permanent hot mix patch at same thickness
or 2-inches and sealed within 30 days.
10 Concrete - saw cut and pored with mastic joints, eight -
sack n-Lix, either type II of III cement, within 30 days.
0
(Cl
PROJECT'S TIMELINE AND PROPOSED HOURS OF OPERATION:
a Timeline — Up to 30-days past the issue date.
0 Work Hours —The entire project area will be conducted from 7:00 AM tolo:00 PM or
as specified by the Inspector.
Traffic Control Plans
1. The standards and guides of the latest version of the MUTCD or as set-up per
Code shall be followed at all times.
2. A copy of the Permit and Traffic Control Plan shall be on -site with all
contractors during the project.
3. All contractors will avoid parking on sidewalks and shoulders and will take the
lane and follow the proper traff ic control se't-up for the given situation.
4. Pedestrian access shall be maintained through or etoured around all work
sites. Ad
SAC-6L;1
5. Please find attached the traffic control plans for the various types of work
sites that will be encountered during our project.
6. Flaggers will be used only when all other methods of traffic control are
inadequate to warn and direct drivers. Only licensed flaggers will be used on
the project.
7. If situations occur when questions arise about proper traffic control set-up the
solution will be determined in the field with the Comcast Construction Rep.
and the Inspector.
C'J
Eftigion, Ofttr6 es:
If curb and gutters in project area:
Filter bags will be placed in catchbasins downstream of work site, and
Small check dams of pea gravel filled sandbags will placed within the
gutter upstream of the catchbasin.
. I..
Traffic control set-up for minor encroachment
Traffic control set-up for lane closure
B
100,
)ace
FLAGGER STAMM